Professional Documents
Culture Documents
Cncer de seno:
de la epidemiologa al tratamiento
Resumen
El cncer de mama es una enfermedad con gran impacto mundial, dado que
es una de las
patologas con ms alta prevalencia en mujeres mayores de 50 aos de
edad y el cncer con
mayor tasa de mortalidad en mujeres en casi todos los pases. Con una
revisin de estudios
de los ltimos 10 aos, este artculo examina la situacin actual del cncer
de mama,
haciendo nfasis en aspectos como epidemiologa, factores de riesgo,
biologa, diagnstico
radiolgico e histolgico, tratamiento quirrgico y farmacolgico,
reconstruccin, recurrencia
y supervivencia. Logramos determinar que, a pesar de que los nuevos
avances en
el diagnstico temprano y el tratamiento ofrecen mejora en la
supervivencia, no se ha
logrado disminuir significativamente el nmero de muertes por esta
enfermedad y el
nmero de nuevos casos va en aumento. Esto se debe, posiblemente, al
poco entendimiento
de esta enfermedad.
Title
Breast cancer
Abstract
Breast cancer is a disease with great worldwide impact due to its being a
disease with high
prevalence in women over 50 years of age and because it is the cancer with
the highest
mortality rate in women in almost every country. With the revision of studies
done in the
past 10 years, this article examines breast cancers current situation,
emphasizing aspects
such as epidemiology, risk factors, biology, radiological and histological
diagnosis, surgical
and pharmacological treatment, reconstruction and survival. We were able
to determine
that in spite the fact that progress in early diagnosis and treatment has
improved survival,
there has not been a significant reduction in the number of deaths caused
by this disease
and the number of new cases is rising. This may be due to low levels of
understanding of
this illness.
Colombia.
Recibido: 19-05-2008 Revisado: 6-06-2008 Aceptado: 27-06-2008
Metodologa de la bsqueda de la
informacin
Epidemiologa mundial y
colombiana
Modificado por Angarita y Acua (2007) de Hulka BS, Moorman PG. Breast
cancer:
hormones and other risk factors. Maturitas. 2001;38:103-16.
Densidad en la mamografa. La
densidad de la mama en la
mamografa vara segn la edad
debido a cambios en la proporcin
de estroma y tejido graso. Al comparar
mujeres con densidad menor
de 10% en la mamografa con
aqullas con densidad mayor de
75%, el odds ratio es 4,7 para cncer
de mama en las mujeres con
senos ms densos[3,26,35,36].
Clnica
Qu se debe buscar?
Histopatologa
Tratamiento
Reconstruccin. La reconstruccin
del seno se hizo primero para prevenir
las deformidades torcicas y reducir las
complicaciones, pero hoy se hace para
proveer bienestar emocional. Es un procedimiento
seguro que no retrasa la terapia
adyuvante, no altera la deteccin
de recurrencias ni aumenta la tasa de
recurrencia[116,118].
Complicacin Frecuencia
(%)
Infeccin del sitio operatorio por Staphylococcus 1 a 20
Seroma 22
Hematoma 2 a 10
Dolor crnico 20 a 30
Tromboembolismo venoso 0,16
Necrosis cutnea 1 a 6
Linfedema de miembro superior 7 a 30
Sintomatologa en miembro superior 73
Inhibidores de la aromatasa. El
estrgeno es la hormona principal que
genera desarrollo y crecimiento del
tumor y, al bloquear los receptores
hormonales, se impide el crecimiento[
75,147]. En la posmenopausia, los
andrgenos producidos por las glndulas
suprarrenales, son transformados
por el tejido adiposo perifrico en
estrgenos a travs de la aromatasa,
constituyndose esta va en la fuente
principal de estrgenos; esto que permite
que los inhibidores de la aroma-
tasa se comporten de forma similar a
los moduladores selectivos del receptor
de estrgeno[75].
La inhibicin de la angiognesis es
un nuevo punto de la farmacologa
oncolgica. El VEGF (vascular
endothelial growth factor) es el regu
Recurrencia
Supervivencia
La supervivencia a 5 aos ha mejorado
desde 1975, de 75 a 86% a principios
de 1990[8,154].
La supervivencia es igual a la de
las mujeres no embarazadas[164,
167,168].
pervivencia[176].
La supervivencia es relativamente
igual que la de las mujeres[174,176].
Conclusin
El estudio del cncer de mama requiere
integrar el conocimiento de muchas
areas del saber mdico. No basta con
entender que es el tumor ms frecuente
en mujeres en el mundo, que el estrgeno
es la molcula responsable de
casi todos los factores de riesgo o que
la mamografa es el mtodo de tamizacin
que ms reduce la mortalidad,
as como que hoy en da la diseccin
axilar de rutina ha sido remplazada por
el ganglio centinela.
Agradecimientos
A nuestros profesores Mauricio Tawil
Moreno, Lilian Torregrosa Almonacid
y lvaro Ruiz Morales, por su incondicional
ayuda y orientacin en la revisin
del artculo.
Bibliografa
1.
World Health Organization. The World
Health Report 2004: changing history.
(France): World Health Organization;
2004;1-170.
2.
Murray CJL, Lpez AD. Mortality by
cause for eight regions of the world:
Global Burden of Disease Study. Lancet.
1997;349:1269-79.
3.
Boyle P. Breast cancer control: signs
of progress, but more work required.
Breast. 2007;14:429-38.
4.
Key TJ, Verkasalo PK, Banks E. Epidemiology
of breast cancer. Lancet.
2001;2:133-40.
5.
Veronesi U, Boyle P, Goldhirsch A, et
al. Breast cancer. Lancet.
2005;365:1727-41.
6.
Pieros M, Ferlay J, Murillo R. Cancer
incidence estimates at the national and
district levels in Colombia. Salud
Pblica Mex. 2006;48:455-65.
7.
McPherson K, Steed CM, Dixon JM.
The ABC of breast disease: Breast cancer-
epidemiology, risk factors, and genetics.
BMJ. 2000;321:624-8.
8.
Lacey JV, Devesa SS, Brinton LA. Re-
cent trends in breast cancer incidence
and mortality. Environ Mol Mutagen.
2002;39:82-8.
9.
American Cancer Society. Cancer facts
and figures 2007. Atlanta: American
Cancer Society; 2007;1-52.
10.
American Cancer Society. Cancer facts
and figures for hispanics/latinos 20062008.
Atlanta: American Cancer Society;
2006;1-32.
11.
Ferlay J, Bray F, Pisani P, et al.
GLOBOCAN 2002: cancer Incidence,
Mortality and Prevelance Worldwide
IARC Cancer Base, No. 5. Version 2.0,
IARCPress, Lyon, 2004.
Angarita F.A., Acua S.A., Cncer de seno: de la epidemiologa al
tratamiento
12.
Ochoa FL, Montoya LP. Mortalidad
por cncer en Colombia 2001. CES
Medicina. 2004;18:19-36.
13.
Rodrguez J. Descripcin de la
mortalidad por departamentos Colombia
ao 2000, [en lnea], Bogot,
CENDEX [citado Noviembre 20,2007],
Formato PDF, Disponible en: http://
www.javeriana.edu.co/cendex/pdf/
DT%20016-05.pdf.
14.
Jemal A, Murray T, Samuels A, et al.
Cancer statistics, 2003. CA Cancer J
Clin. 2003;53:5-26.
15.
Pieros M, Hernndez G, Bray F. Increasing
mortality rates of common malignancies
in Colombia: an emerging
problem. Cancer. 2004;101:2285-92.
16.
Li CI, Anderson BO, Daling JR, et al.
Trends in incidence rates of invasive
lobular and ductal breast carcinoma.
JAMA. 2003;289:1421-4.
17.
Iglehart JD, Smith BL. Disease of the
breast. In: Townsend CM, Beauchamp
RD, editors. Sabiston textbook of surgery:
the biological basis of modern surgical
practice, 17th edition. (Canada):
Elsevier; 2004.
18.
Hulka BS, Moorman PG. Breast cancer:
hormones and other risk factors.
Maturitas. 2001;38:103-16.
19.
Miser WF. Cancer screening in the primary
care setting. Prim Care Clin Office
Pract. 2007;34:137-67.
20.
BRIDGE Study Group. The presentation
and management of breast symptoms
in general practice in South Wales.
Br J Gen Pract. 1999;49:811-2.
21.
RoshanLall C, Leinster S, Mitcherl S,
et al. Current patterns of referral in
breast disease. Breast. 2000;9:334-7.
22.
Barton MB, Elmore JG, Fletcher SW.
Breast symptoms among women enrolled
in a health maintenance organization:
frequency, evaluation, and
outcome. Ann Intern Med.
1999;130:651-7.
23.
Lumachi F, Ermani M, Brandes AA, et
al. Breast complains and risk of breast
cancer. Population based study of 2,879
self-selected women and long-term follow-
up. Biomed Pharmacother. 2002;
56:88-92.
24.
Seltzer MH. Breast complaints, biopsies,
and cancer correlated with age in
10,000 consecutive new surgical referrals.
Breast J. 2004;10:111-7.
25.
Clemons M, Goss P. Estrogen and the
risk of breast cancer. N Engl J Med.
2001;334:276-85.
26.
Clamp A, Danson S, Clemons M. Hormonal
risk factors for breast cancer:
identification, chemoprevention, and
other intervention strategies. Lancet
Onc. 2002;3:611-9.
27.
Newman LA, Vogel VG. Breast cancer
risk assessment and risk reduction. Surg
Clin N Am. 2007;87:307-16.
28.
Clavel-Chapelon F, Launoy G, Auquier
A, et al. Reproductive factors and breast
cancer risk: effect of age at diagnosis.
Ann Epidemiol. 1995;5:315-20.
29.
Olaya-Contreras P, Pierre B, Lazcano-
Ponce E, et al. Factores de riesgo
reproductivo asociados al cncer
mamario, en mujeres colombianas. Rev
Saude Publica. 1999;33:237-45.
30.
Collaborative Group on Hormonal Factors
in Breast Cancer. Breast cancer and
hormonal contraceptives: collaborative
reanalysis of individual data on 53297
Univ. Md. Bogot (Colombia), 49 (3): 344-372, julio-septiembre de 2008
women with breast cancer and 100239
women without breast cancer from 54
epidemiological studies. Lancet.
1996;347:1713-27.
31.
Collaborative Group on Hormonal Factors
in Breast Cancer. Breast cancer and
hormone replacement therapy: collaborative
reanalysis of data from 51 epidemiological
studies of 52,705 women
with breast cancer and 108,411 women
without breast cancer. Lancet.
1997;350:1047-59.
32.
Lobelo F, Pate R, Parra D. Carga de
mortalidad asociada a la inactividad
fsica en Bogot. Rev Salud Pblica.
2006;8(Supl.2):28-41.
33.
Friedenriech CM, Orenstein MR. Physical
activity and cancer prevention:
etiologic evidence and biological
mechanisms. J Nutr. 2002;132:3456S64S.
34.
Ellison RC, Zhang Y, McLennan CE, et
al. Exploring the relation of alcohol
consumption to risk of breast cancer.
Am J Epidemiol. 2001;154:740-7.
35.
Boyd NF, Guo H, Martin LJ, et al. Mammographic
density and the risk and
detection of breast cancer. N Engl J
Med. 2007;356:227-36.
36.
Warwick J, Pinney E, Warren RML, et
al. Breast density and breast cancer
risk factors in a high-risk population.
Breast. 2003;121:10-6.
37.
Morrow M, Gradishar W. Recent developments:
breast cancer. BMJ.
2002;324:410-4.
38.
Jatoi I. Breast cancer screening. Am J
Surg. 1999;177:518-24.
39.
Tang TS, Solomon LJ, McCracken LM.
Cultural barriers to mammography, clini
40.
Knutson D, Steiner E. Screening for
breast cancer: current recommendations
and future directions. Am Fam
Physician. 2007;5:1660-6.
41.
Hacksaw AK, Paul EA. Breast self-examination
and death from breast cancer:
a meta-analysis. Br J Cancer.
2003;88:1047-53.
42.
Thomas DB, Gao DL, Ray RM, et al.
Randomized trial of breast self-examination
in Shanghai: final results. J Natl
Cancer Inst. 2002;94:1445-57.
43.
Smith EM, Francis AM, Polissar L. The
effect of breast self-exam practices and
physician examinations on extent of
disease at diagnosis. Prev Med.
1980;9:409-17.
44.
Toner, LCM, Jordell N. Screening and
breast cancer: the role of breast awareness.
Cancer Nurs. 1997;2:76-80.
45.
Chagpar AB, McMasters KM. Trends
in mammography and clinical breast
examination: A population-based
study. J Surg Res. 2007;140:214-9.
46.
Saslow D, Hannan J, Osuch J, et al.
Clinical breast examination: Practical
recommendations for optimizing performance
and reporting. CA Cancer J
Clin. 2004;54:327-44.
47.
U.S. Preventive Services Task Force.
Screening for breast cancer: Recommendation
s and rationale. Ann Intern
Med. 2002;137:344-6.
48.
Duffy SW, Smith RA, Gabe R, et al.
Screening for breast cancer. Surg
Oncol Clin N Am. 2005;14:671-97.
Angarita F.A., Acua S.A., Cncer de seno: de la epidemiologa al
tratamiento
49.
Whitman G, Sheppard D, Phelps M.
Breast cancer staging. Semin
Roentgenol. 2006;41:91-104.
50.
Barth RJ, Gibson GR, Carney PA, et al.
Detection of breast cancer on screening
mammography allows patients to
be treated with less-toxic therapy. AJR.
2005;184:324-9.
51.
Bartella L, Smith C, Dershaw D, et al.
Imaging breast cancer. Radiol Clin N
Am. 2007;45:45-67.
52.
Kubik-Huch R. Imaging the young
breast. Breast. 2006;15:S35-40.
53.
Hansen N, Growney A. Breast cancer:
pre- and postoperative imaging for
staging. Surg Oncol Clin N Am.
2007;16:447-63.
54.
Wyld L, Ingram CE. Screening of the
population for breast cancer. Surgery.
2007;25:254-6.
55.
Spencer DB, Potter JE, Chung MA, et
al. Mammographic screening and disease
presentation of breast cancer patients
who die of disease. Breast J.
2004;10:298-303.
56.
Biesheuved C, Barratt A, Howard K, et
al. Effects of study methods and biases
on estimates of invasive breast cancer
overdetection with mammography
screening: a systematic review. Lancet
Oncol. 2007;8:1129-38.
57.
Crystal P, Strano SD, Shcharynski S,
Koretz MJ. Using sonography to screen
women with mammographically dense
breasts. Am J Roentgenol. 2003;181:
177-82.
58.
Ferrini R, Mannino E, Ramsdell E, et
al. Screening mammography for breast
cancer: American college of preventive
medicine practice policy statement.
59.
Pisano E, Zuley M, Baum J, et al. Issues
to consider in converting to digital
mammography. Radiol Clin N Am.
2007;45:813-30.
60.
Brenner R, Parisky Y. Alternative
breast-imaging approaches. Radiol
Clin N Am. 2007;45:907-23.
61.
Whitman G, Erguvan-Dogan B, Tse W,
et al. Ultrasound-guided breast biopsies.
Ultrasound Clin. 2007;1:603-15.
62.
Yang W, Dempsey P. Diagnostic breast
ultrasound: Current status and future
directions. Radiol Clin N Am.
2007;45:845-61.
63.
Sim LS, Hendriks JH, Fook-Chong Sm.
Breast ultrasound in women with familial
risk of breast cancer. Ann Acad
Med Singapore. 2004;33:600-6.
64.
Westenend PJ, Sever AR, Beekman-de
Volder HJ, et al. A comparison of aspiration
cytology and core needle biopsy
in the evaluation of breast lesions.
Cancer (Cancer Cytopathol). 2001;
93:146-50.
65.
Shannon J, Douglas-Jones AG, Dllimore
NS. Conversion to core biopsy in preoperative
diagnosis of breast lesions:
is it justified by results? J Clin Pathol.
2001;54:762-5.
66.
Masetti R, Terribile D, Antinori A, et al.
Breast cancer in older women. Breast
J. 1998;4:55-61.
67.
Page, DL. Special types of invasive
breast cancer, with clinical implica-
Univ. Md. Bogot (Colombia), 49 (3): 344-372, julio-septiembre de 2008
tions. Am J Surg Pathol. 2003;27:
832-5.
68.
Harake MD, Maxwell AJ, Sukumar SA.
Primary and metastatic lobular carcinoma
of the breast. Clin Radiol.
2001;56:621-30.
69.
Weigelt B, Peterse JL, vant Veer LJ. Breast
cancer metastasis: markers and models.
Nat Rev Cancer. 2005;5:591-602.
70.
Carrera JL, Jaramillo LF. Prevalencia de
las lesiones tumorales malignas en el
Hospital Universitario de San Ignacio
periodo 1990 - 1999. Universitas
Mdica. 2000;41:
71.
Gonzlez-Mario MA. Cncer de seno
en la Clnica San Pedro Claver de
Bogot, 2004. Rev Salud Pblica.
2006;8:163-9.
72.
Allemani C, Sant M, Berrino F, et al.
Prognostic value of morphology and
hormone receptor status in breast cancer
- a population-based study. Br J
Cancer. 2004;91:1263-8.
73.
Porter GJ, Evans AJ, Pinder SE, et al.
Patterns of metastatic breast carcinoma:
influence of tumour histological
grade. Clin Radiol. 2004;59:
1094-8.
74.
Clements DM, Holland PA. Metastatic
disease of the breast and local recurrence
of breast cancer. Surgery.
2007;25:276-9.
75.
Fentiman I. Aromatase inhibitors and
breast cancer: time for a change? Int J
Clin Pract. 2004;58:1152-8.
76.
Caicedo J, Quintero E, Robledo J.
Cncer de seno y hormonoterapia:
Estado actual. Rev Colomb Cir.
2007;22:47-71.
77.
Murphy L, Watson P. Steroid receptors
in human breast tumorigenesis and
breast cancer progression. Biomed
Pharmacother. 2002;56:65-77.
78.
Barnes D, Hanby A. Oestrogen and
progesterone receptors in breast cancer:
past, present and future. Histopathology.
2001;38:271-4.
79.
Kaufman M. Review of known prognostic
variables. Results Probl Cell Differ.
2000;140:77-87.
80.
Masood S. Prognostic factors in breast
cancer. Breast J. 1997;3:267-83.
81.
Brennan P, Green M. Her2/neu. Encyclopedia
of Cancer. 2002;2:387-405.
82.
Eubesi E, Cummings M, Farshid G, et
al. Breast cancer-the role of the
pathologis and targeted therapies/optimal
pathology reporting. Path Int.
2004;54(Suppl.1):S10-24.
83.
Slamon DJ, Godolphin W, Jones LA, et
al. Studies of the HER-2/neu protooncogene
in human breast and ovarian
cancer. Science. 1989;244:707-12.
84.
Climent M, Segui A, Peiro G. Prognostic
value of HER-2/neu and p53 expression
in node-positive breast cancer.
HER-2/neu effect on adjuvant tamoxifen
treatment. Breast. 2001;10:67-77.
85.
Ross J, Fletcher J. The HER-2 neu
oncogene: prognostic factor, predictive
factor and target for therapy. Semin
Cancer Biol. 1999;9:125-38.
86.
Musolino A, Bella M, Bortesi B. BRCA
mutations, molecular markers, and
clinical variables in early-onset breast
cancer: a population-based study.
Breast. 2007;16:280-92.
Angarita F.A., Acua S.A., Cncer de seno: de la epidemiologa al
tratamiento
87.
Meja M, Jaramillo LF. Carcinoma
canalicular infiltrante de glndula
mamaria: anlisis descriptivo Hospital
Universitario San Ignacio, 1995 - 2002.
Universitas Mdica. 2004;45:13-6.
88.
Vital VS, Prez I. Evolucin del cncer
mamario. Experiencia clnica de cinco
aos en un hospital urbano. Ginec Obst
Mex. 1998;66:92-7.
89.
Ueno M, Kiba T, Nishimura T, et al.
Changes in survival during the past two
decades for breast cancer at the Kyoto
University Hospital. EJSO. 2007;
33:696-9.
90.
Feig SA. Auditing and benchmarks in
screening and diagnostic mammography.
Radiol Clin N Am. 2007;45:791800.
91.
Louwman WJ, Vulto JCM, Verhoeven
RHA, et al. Clinical epidemiology of
breast cancer in the elderly. Eur J Cancer.
2007;43:2242-52.
92.
Maggard MA, OConnell JB, Lane KE.
Do young breast cancer patients have
worse outcomes? J Surg Res. 2003;
113:109-13.
93.
Agnese D, Yusuf F, Wilson J. Trends in
breast cancer presentation and care
according to age in a single institution.
Am J Surg. 2004:188:437-9.
94.
Greene F, Page DL, Fleming ID, editors.
AJCC Cancer Staging Manual, 6th ed.
New York: Springer; 2002.
95.
Nicolini A, Giardino R, Carpi A, et al.
Metastatic breast cancer: an updating.
Biomed Pharmacother. 2006;60:548
56.
96.
Tawil M, Escalln A, Torregrosa L.
Ciruga de cncer de seno: pasado,
presente y futuro. Universitas Mdica.
2003;44
97.
Veronesi U, Cascinelli N, Mariani L.
Twenty-year follow-up of a randomized
study comparing breast-conserving
surgery with radical mastectomy for
early breast cancer. N Eng J Med.
2002:347:1227-32.
98.
Poggi MM, Danforth DN, Sciuto LC, et
al. Eighteen-year results in the treatment
of early breast carcinoma with
mastectomy versus breast conservation
therapy. Cancer. 2003;98:697-702.
99.
van Dongen J, Voogd A, Fentiman I, et
al. Long-term results of a randomized
trial comparing breast-conserving
therapy with mastectomy: European
Organization for Research and Treatment
of Cancer 10801 Trial. J Natl Cancer
Inst. 2000;92:1143-50.
100. Gil J, Lpez M, Rebollo F, et al. Cncer
de mama y mastectoma: estado actual.
Cir Esp. 2001;69:56-64.
101. Morrow M, Strom E, Basset L,
et al.
Standard for breast conservation
therapy in the management of invasive
breast carcinoma. CA Cancer J Clin.
2002;52:277-300.
102. Fisher B, Bauer M, Margolese R, Poisson
R, Redmond C, Fisher E, et al. Fiveyear
results of a randomized clinical trial
comparing total mastectomy and seg-
mental mastectomy with or without radiation
in the treatment of breast cancer.
N Engl J Med. 1985;312:665-73.
141. Lonning P.
Adjuvant endocrine treatment
of early breast cancer. Hematol
Oncol Clin N Am. 2007;21:223-38.
142. ATAC Trialists Group. Anastrozole
alone or in combination with tamoxifen
versus tamoxifen alone for adjuvant
treatment of postmenopausal
women with early breast cancer: first
results of the ATAC randomized trial.
Lancet. 2002;359:2131-9.
143. Levine M. Adjuvant therapy and
thrombosis: how to avoid the problem?
Breast. 2007;16:S169-74.